KINGSTON, Ont. — Three teenage Montreal sisters and their stepmother found dead in a submerged car could have been drowned elsewhere and then stuffed into the vehicle before it plunged into a shallow canal, the Shafia murder trial heard Monday.

“From a pathology perspective, I cannot include or exclude that … it is possible,” forensic pathologist Dr. Christopher Milroy testified.

But thorough toxicology tests found the victims had no signs of drugs or alcohol in their bodies.

On a trying day for jurors, they were shown ghastly photos of three of the victims with the skin on their heads peeled back to reveal bruises on their crowns or foreheads.

Milroy, a professor at the University of Ottawa, was asked by prosecutor Gerard Laarhuis if his findings make it more or less plausible that the victims were either incapacitated or drowned elsewhere than Kingston Mills — the remote spot along the Rideau Canal where they were found June 30, 2009 in a submerged car — before the vehicle went into the water.

Milroy said the pathology is “neutral” on the proposition.

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The conclusion came at the end of the doctor’s 90-minute testimony based on his autopsies of the four victims, which found that all died of drowning. Milroy said he could not say when or how the victims drowned.

He said thorough toxicology tests did not find any evidence that the victims were incapacitated or sedated with any drugs or toxins.

Mohammad Shafia, 58, clutched a tissue to his face and appeared to sob as graphic photos from the autopsies were flashed onto large monitors in the courtroom. His son, Hamed, 20, sitting beside him in the prisoner’s box, also held a tissue to his face but did not appear distraught. Tooba Mohammad Yahya, 41, was permitted to remain out of the courtroom for all of Milroy’s testimony.

The three are each charged with four counts of first-degree murder. They have pleaded not guilty to murdering four family members, sisters Zainab, 19, Sahar, 17, Geeti, 13, and Rona Amir Mohammad, 52, Shafia’s first wife, whom he married in his native Afghanistan.

Jurors were shown ghastly photos of three of the victims, Rona, Zainab and Geeti, with the skin on their heads peeled back to reveal bruises on their crowns or foreheads.

“It clearly requires explanation and what is somewhat unusual is that they have three areas of impact to the head and there is a relative absence of injury elsewhere on the body,” Milroy testified. He could not explain the bruises. Rona had the most significant injuries.

“It’s a fairly substantial area of bruising,” Milroy testified. Only Sahar did not have the mysterious bruises on her head.

The other victims also had minor bruises, discovered during internal examinations, in the muscles around the neck, shoulders and chest. These were likely caused during the dying process, Milroy testified.

Defence lawyers have not yet had a chance to question the pathologist.